ABSTRACT
PURPOSE: Although commonly performed in adults, laparoscopic adrenalectomy in children is performed only in centres with advanced laparoscopic expertise. MATERIALS AND METHODS: This is a retrospective analysis of laparoscopic adrenalectomies performed at a single centre between January 2003 and May 2010. After preoperative evaluation with biochemical assays and radiologic imaging, surgery was performed by using the lateral transabdominal approach in all patients. RESULTS: Ten laparoscopic adrenalectomies (including three bilateral) were performed in seven children, with a mean age of 9.6 years. The tumours ranged from 2 - 7 cms in size. The operative durations were 75 - 130 minutes (unilateral) and 250 - 270 minutes (bilateral). Operative blood loss was minimal. There were no open conversions, but terminal hand assistance was required in one large right pheochromocytoma. The postoperative hospital stay ranged from 3 - 10 days. The final pathological diagnoses included pheochromocytoma, hyperplasia and neuroblastoma. Follow-up at 24 - 87 months was uneventful. CONCLUSION: With adequate experience in laparoscopy, it is possible to perform adrenalectomy in selected children.
ABSTRACT
OBJECTIVES: To determine the level and prevalence of anxiety and depression in men being investigated for prostate cancer (CaP) and also to identify those aspects of the diagnostic pathway that induces the most stress. MATERIALS AND METHODS: All patients undergoing transrectal ultrasound-guided biopsy (TRUS-B) of the prostate for suspected CaP at our institute between June 2008 and April 2009 were enrolled in this prospective study. All patients completed two questionnaires, prior to their biopsy (HADS1) and before receiving results (HADS2), containing the Hospital Anxiety and Depression Scale (HADS). The data were analyzed and the differences in HADS were compared. RESULTS: A total of 112 men were included in the trial. Two patients could not complete the second part of HADS (HADS2) and were excluded from the study. Prevalence of anxiety among the 110 patients was 43/110 (39.1%). Mean score for anxiety in these 43 patients before biopsy (HADS A1) was 10.74 and score just before receiving the biopsy report (HADS A2) was 11.55. Prevalence of depression before TRUSB (HADS D1) was 21/110 (19.1%) with a mean score of 10.59. Prevalence of depression while awaiting the biopsy report (HADS D2) was 22/110 (20%) with mean score of 10.62. CONCLUSION: There was a high prevalence of anxiety and depression in our study population and waiting for biopsy results was the most stressful event. Questionnaires such as HADS can identify patients with psychological distress. Minimizing the stress while waiting for a diagnosis should help optimize patient care.
ABSTRACT
Persistent hematuria is one of the most dreaded complications following percutanous nephrolithotomy (PCNL). Although invasive, a catheter-based angiogram is usually used to localize the bleeding vessel and subsequently embolize it. Advances in imaging technology have now made it possible to use a non invasive multi-detector computed tomography (MDCT) angiogram with 3-D reconstruction to establish the diagnosis. We report a case of post-PCNL hemorrhage due to a pseudo aneurysm that was missed by a conventional angiogram and subsequently detected on MDCT angiogram.
ABSTRACT
Schwannoma is a benign tumour arising from neurilemmal cells and is commonly seen along cranial nerves. We describe the case history and histologic findings of a young adult with a schwannoma at a very rare site: the penis. Surgical excision was done and the patient remains disease-free after 2 years.
Subject(s)
Neurilemmoma/pathology , Neurilemmoma/surgery , Penile Neoplasms/pathology , Penile Neoplasms/surgery , Adult , Humans , Male , Treatment OutcomeABSTRACT
Idiopathic retroperitoneal fibrosis (RPF) is one of the causes of obstructive uropathy. This disease, ever since its original description in 1948, has undergone much trial and error in its management. We present a case of a rare type of idiopathic RPF causing obstructive uropathy, which is perirenal and different from the classical RPF seen around the great vessels. To our knowledge, such a type of RPF has not been described. We treated the patient by a combined surgical approach in the form of ureterolysis and omentoplasty, followed by medical management with steroids and tamoxifen. The combined regimen yielded excellent results, and the patient is doing well at 9 months of follow up. The rarity of the presentation, with predominant bilateral perirenal fibrosis, and response of perirenal RPF to steroids and tamoxifen, is highlighted in this case presentation.
